Wayne State University School of Medicine Detroit, MI, United States
Deven Gupta, BS1, Syed-Mohammed Jafri, MD2, Kimberly Brown, MD3, Stuart Gordon, MD2 1Wayne State University School of Medicine, Detroit, MI; 2Henry Ford Health System, Detroit, MI; 3Henry Ford Hospital, Detroit, MI
Introduction: We present an unusual case of abdominal pain and fever leading to a diagnosis of syphilitic hepatitis.
Case Description/Methods: A 37 year old male presented to the emergency room with persistent night sweats, weight loss, lower back and lower abdominal discomfort. Two months earlier, the patient was referred to a surgeon for possible cholecystitis and was later referred to hepatology for raised alkaline phosphatase and possible primary sclerosing cholangitis. Physical exam showed diffuse cervical, axillary, and inguinal lymphadenopathy and a widespread macular rash. Labs were significant for an elevated alkaline phosphatase levels to 280 IU/L. A liver biopsy only showed non-specific mild mixed portal inflammation whereas a lymph node biopsy showed non-necrotizing granulomatous inflammation. Subsequent investigation revealed a notable increase in RPR and a positive Treponema pallidum particle agglutination assay. Given reduced hearing, lumbar puncture was performed showing 19 WBC / cu mm, 71% lymphocytes and protein 45.9 mg/dL resulting in a neurosyphilis diagnosis. He was then treated with 4 million units of intravenous penicillin every 4 hours x 14 days with clinical improvement. On follow up, the patient’s alkaline phosphatase levels declined toward normal, with rapid resolution of fever, and lymph node swelling and rash improving more slowly.
Discussion: Syphilis is a sexually transmitted infection caused by Treponema pallidum. It is generally characterized as a progression from chancre to central nervous system involvement if untreated; chancre was not observed in this patient. The dominant presenting symptoms in this case included night sweats, lymphadenopathy, abdominal pain, and cholestatic liver tests. Given the positive serologies, his abnormal liver profile was likely due to syphilitic hepatitis. The clinical improvements in response to penicillin further supports the diagnosis. Syphilitic hepatitis is a potential complication of syphilis. Our patient reported no primary chancre or risk factors and presented with abdominal pain and biochemical cholestasis. A high clinical suspicion and early treatment are key to successful recovery.
Deven Gupta indicated no relevant financial relationships.
Kimberly Brown indicated no relevant financial relationships.
Stuart Gordon indicated no relevant financial relationships.
Deven Gupta, BS1, Syed-Mohammed Jafri, MD2, Kimberly Brown, MD3, Stuart Gordon, MD2. P2880 - Syphilitic Hepatitis: An Unusual Manifestation of Abdominal Pain in a Young Patient, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.